Individual
MS. KECIA THOMPSONGORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1905 W HART RD, BELOIT, WI 53511-2230
(608) 365-7500
Mailing address
710 CAMPUS ST APT 5, MILTON, WI 53563-1747
(608) 868-6130
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2959
WI
Other
Enumeration date
05/04/2020
Last updated
05/04/2020
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